5 Peds Psych, ADHD, & Psychopharm Review Flashcards
ADHD is a persistent pattern of ________ and/or _____________ that is more frequently displayed and more severe than is typically observed in individuals at a ____________ of development.
Inattention and/or hyperactivity-impulsivity
Comparable level
DSM-5 diagnostic criteria for ADHD
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that INTERFERES with functioning or development, as characterized by (1) and/or (2)
- 6 or more Inattention symptoms for at least 6 months, inconsistent with developmental level and negatively impacts on social and academic/occupational activities
- 6 or more Hyperactivity-Impulsivity symptoms for at least 6 months, inconsistent with developmental level and negatively impacts on social and academic/occupational activities
B. Symptoms present prior to age 12
C. Symptoms present in 2 or more settings
D. Clear evidence symptoms interfere with, or reduce quality of, social, academic, or occupational functioning
To meet DSM-5 criteria for ADHD you need 6 or more of these inattention symptoms…
Careless mistakes due to inattention Difficulty sustaining attention Does not listen when spoken to directly Does not follow through or finish work Difficulty organizing tasks Avoids tasks that require sustained mental effort Loses things necessary for tasks Easily distracted by extraneous stimuli Forgetful in daily activities
To meet DSM-5 criteria for ADHD you need 6 or more of these hyperactivity-impulsivity symptoms…
Fidgets
Leaves seat when sitting in seat is expected
Runs/climbs excessively in inappropriate situations
Difficulty playing/engaging in leisurely activities quietly
“On the go”
Talks excessively
Blurts out answers prematurely
Difficulty awaiting turn
Interrupts or intrudes others
Specifiers for ADHD diagnosis
Specify whether Combined Type, Predominantly Inattention Type, or Predominantly Hyperactive-Impulsive Type
Specify whether in partial remission (<6 Sx for 6 months or more after previous full diagnosis)
Specify current severity (Mild, Moderate, or Severe)
Prevalence of ADHD
5% of children
2.5% of adults
M:F = 2-4:1
ADHD is difficult to diagnose in younger children (<5) due to…
Age-appropriate behaviors in active children (DON’T give them meds)
Also, parents can be unreliable historians
ADHD is most common in ________ children
Elementary school-aged
Make sure to obtain info from TEACHERS (parents often unreliable historians)
What two things should you keep in mind when diagnosing ADHD in adulthood?
If comorbid with SUD, Mood Disorder, or Anti-Social Personality, increased risk of SUICIDE
For new diagnoses, use caution with basing diagnosis on patient’s childhood recall of ADHD (OBTAIN SCHOOL RECORDS)
Some DDx for ADHD that can co-occur with the condition
Age-appropriate behaviors in active children LEARNING DISORDER Depression/Bipolar disorder Anxiety Post-traumatic stress disorder Stereotypic movement disorder OPPOSITIONAL DEFIANCE DISORDER CONDUCT DISORDER SUBSTANCE ABUSE
Environmental factors that may contribute to ADHD
Stressful home
Inappropriate schools
Under-stimulated environments
Medical conditions that may confound Dx of ADHD
HEARING/VISUAL IMPAIRMENTS*** Lead poisoning Asthma FAS Thyroid abnormalities Sleep disorders Seizures
A comprehensive medical, developmental, educational, and psychosocial evaluation is done for patients suspected of having ADHD, in order to…
Confirm symptoms
Demonstrate functional complications
Exclude other explanations for symptoms
Identify comorbid psychiatric conditions
Other evaluation tips for ADHD
Eval may be done in primary care
Review of medical, social, and family histories should be included
Interview both patient and parents
Collect info from other caregivers and TEACHERS
What do we need to know about rating scales for ADHD?
There are several scales but Dx still REQUIRES validation with DSM-5
Pediatric scales:
• Vanderbilt Assessment Scale (primary care and in referral for 4+ yo)
• Conners Comprehensive Behavior Rating Scales (ok for preschool)
• ADHD Rating Scale IV (preschool ok)
Adult:
• ASRS (ADHD Self Report Scale)
• CAARS (Conners Adult ADHD Rating Scale)
CAARS should be completed at time of Dx, during med titration, and at regular medication follow-up visits
What sorts of questions should you ask of parents?
How is your child doing in school?
Have you or the teacher noticed any problems with learning?
Is your child happy in school?
Does your child have any behavioral problems at school or home or when playing with friends?
Does your child have problems completing school assignments at school or home?
What questions should you ask of teachers?
How is the child’s behavior in school?
What interventions does the child require?
What are the child’s learning patterns?
Is there functional impairment?
How does the child get along with others?
How is the child’s work?
How are the child’s grades?
What is the pathophysiology of ADHD?
- Environmental factors
Pre-, peri-, and post-natal complications
Childhood diseases
Trauma, toxins, drug exposures - Neurotransmitter alterations
Decreased dopamine and/or NE availability in cortex - Neuroanatomical changes in circuits
Pre-frontal cortex, parietal cortex, striatum, and cerebellum
What neurotransmitters are produced by the RAS?
NE
Serotonin
Dopamine
Acetylcholine
The targets for NTs produced by the RAS are …
Discrete nuclei within the basal forebrain, limbic system, and cerebral cortex
Where is Norepinephrine produced?
Locus Coeruleus (LC) - a part of RAS
Norepinephrine targets Cortex, Hypothalamus, and Brainstem for…
Arousal and sleep/wake cycles
Consciousness
Norepinephrine targets Cortex for regulating…
Attention
Norepinephrine targets Cortex and Limbic System for regulating…
Mood
Learning and Memory
